HIV positivity, Coverage and adherence to the Early Infant Diagnosis testing algorithm, among HIV-exposed infants in Uganda: a seven-year national study, 2017–2023

Background Uganda has made substantial progress in preventing mother-to-child transmission (PMTCT) of HIV; however, the performance and contribution of the Early Infant Diagnosis (EID) program has not been comprehensively evaluated at a national level. This study assessed trends in EID HIV positivity rates, coverage, adherence to the national testing algorithm, and associated risk factors among HIV-exposed infants (HEI) in Uganda from 2017 to 2023. Methods We conducted a retrospective secondary data analysis of routinely archived national EID program data from 2017–2023. Key outcomes included EID coverage within two months of birth, adherence to the national EID testing algorithm, HIV positivity rates among HEI among 18 months old infants. Trends over the years, regional variations, and the impact of the COVID-19 period were evaluated. Multilevel mixed effect logistic regression was used to identify associated factors to HIV positivity. Results A total of 884,208 eligible records were analyzed. HIV positivity among HEI declined significantly from 3.0% in 2017 to 1.4% in 2023 (p < 0.01), reflecting important progress toward elimination of mother-to-child transmission (eMTCT). Coverage of first PCR testing within two months of birth and adherence to national EID testing algorithm varied across the years with no significant increase (P > 0.05). Consequently, there was marked decline in adherence after the first PCR tests. Regional disparities were evident in coverage, adherence, and HIV positivity rates. Absence of maternal postnatal antiretroviral therapy (OR = 5.1) and delivery outside a health facility (OR = 3.5) were the strongest associated factors to infant HIV positivity. Discussion Uganda’s EID program has contributed to the reduction of vertical HIV transmission, by providing rapid identification of HEI infection status and supporting linkage into care for the positive ones. Despite these achievements, testing coverage and adherence to the EID testing algorithm remain suboptimal, and significant regional inequities persist. Strengthening retention across the 18-month testing continuum by targeting vulnerable mothers, as well as focusing on poor performing regions will be critical to achieving and sustaining eMTCT goals. Trial registration : Not applicable.